Beers criteria as a proxy for inappropriate prescribing of other medications among older adults

Brian C Lund; Michael A Steinman; Elizabeth A Chrischilles; Peter J Kaboli

doi:10.1345/aph.1Q361

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Beers criteria as a proxy for inappropriate prescribing of other medications among older adults

Journal article

Peer reviewed

Beers criteria as a proxy for inappropriate prescribing of other medications among older adults

Brian C Lund, Michael A Steinman, Elizabeth A Chrischilles and Peter J Kaboli

The Annals of pharmacotherapy, Vol.45(11), pp.1363-1370

11/2011

DOI: 10.1345/aph.1Q361

PMCID: PMC3906722

PMID: 21972251

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https://www.ncbi.nlm.nih.gov/pmc/articles/3906722View

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Abstract

The Beers criteria are a compilation of medications deemed potentially inappropriate for older adults, widely used as a prescribing quality indicator. To determine whether Beers criteria serve as a proxy measure for other forms of inappropriate prescribing, as measured by comprehensive implicit review. Data for patients 65 years and older were obtained from the Veterans Affairs Enhanced Pharmacy Outpatient Clinic (EPOC) and the Iowa Medicaid Pharmaceutical Case Management (PCM) studies. Comprehensive measurement of prescribing quality was conducted using expert clinician review of medical records according to the Medication Appropriateness Index (MAI). MAI scores attributable to non-Beers medications were contrasted between patients who did and did not receive a Beers criteria medication. Beers criteria medications accounted for 12.9% (EPOC) and 14.0% (PCM) of total MAI scores. Importantly, non-Beers MAI scores were significantly higher in patients receiving a Beers criteria medication in both studies (EPOC: 15.1 vs 12.4, p = 0.02; PCM: 11.1 vs 8.7, p = 0.04), after adjusting for important confounding factors. Beers criteria utility extended beyond direct measurement of a limited set of inappropriate prescribing practices by serving as a clinically meaningful proxy for other inappropriate practices. Using prescribing quality indicators to guide interventions should thus identify patients for comprehensive medication review, rather than identifying specific medication targets for discontinuation. Future research should explore both the quality measurement and the intervention targeting applications of the Beers criteria, particularly when integrated with other indicators.

Inappropriate Prescribing - adverse effects

Age Factors

Humans

Medication Errors - adverse effects

Medication Errors - prevention & control

Cooperative Behavior

Pharmacists - standards

Male

Inappropriate Prescribing - prevention & control

Drug Prescriptions - standards

Iowa

Proxy

Polypharmacy

Medical Records - standards

Female

Aged

Drug Utilization Review - standards

Pharmaceutical Preparations - administration & dosage

Details

Title: Subtitle: Beers criteria as a proxy for inappropriate prescribing of other medications among older adults
Creators: Brian C Lund - Center for Comprehensive Access and Delivery Research and Evaluation, Veterans Affairs Iowa City Health Care System, Iowa City, IA, USA. Brian.Lund@va.gov
Michael A Steinman
Elizabeth A Chrischilles
Peter J Kaboli
Resource Type: Journal article
Publication Details: The Annals of pharmacotherapy, Vol.45(11), pp.1363-1370
DOI: 10.1345/aph.1Q361
PMID: 21972251
PMCID: PMC3906722
NLM abbreviation: Ann Pharmacother
ISSN: 1060-0280
eISSN: 1542-6270
Publisher: United States
Grant note: K23-AG030999 / NIA NIH HHS U18 HS016094 / AHRQ HHS 5 U18 HSO16094 / PHS HHS K23 AG030999 / NIA NIH HHS
Language: English
Date published: 11/2011
Academic Unit: Pharmacy; Epidemiology; Internal Medicine
Record Identifier: 9983996192902771

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